Intersexualization

The Clinic and the Colony

Lena Eckert

• Publisher: Routledge
• Year: 2016
• eBook ISBN: 9781317274100
• Edition: 1
• Topic: Scienze sociali
• Subtopic: Femminismo e teoria femminista

Since the 1970s, research into 'Intersex' has been a central fascination for feminist theorists seeking to make arguments about how men and women are created as social/gender categories. Intersexualization: The Clinic and the Colony takes the case of Olympic runner Caster Semenya as a starting point to explore the issue of determining sex, and the ways in which intersexuality is a 'threat' to the distinction between men/women, homosexuality/heterosexuality and white/black.

By focusing on the 1950s and the 40 years after, Eckert shows how what she calls intersexualization began in psycho-medical research at the Johns Hopkins Hospital in Baltimore and UCLA, and has from there spread into cross-cultural anthropological accounts conducted in Papua New Guinea and the Dominican Republic. With cross-cultural intersexualization having been largely neglected in recent literature on intersex, this timely volume describes how such intersexualization derives from the combination of medicalization and pathologization through two crucial parts. The first part, "The Clinic, " describes historical psycho-medical material engaging with hermaphroditism ranging from Greek Mythology up to today. This is followed by "The Colony, " which analyzes, in several close-readings, cross-cultural anthropological, sexological and psychoanalytical accounts contributing to cross-cultural intersexualization.

Enclosing a wide range of inter- and transdisciplinary approaches to heteronormative and dichotomously organized frames of knowledge and organization, this volume is essential reading for upper-undergraduate and post-graduate students within the fields of gender studies, social studies of medicine, anthropology, science and technology studies, cultural studies, sociology, and history of medicine.

Part I
The Clinic

1
Pathologization and Surgery

From 1955 to 1957, the Bulletin of the Johns Hopkins Hospital published five articles on so-called hermaphroditic conditions, including an article entitled “Recommendations Concerning Assignment of Sex” by John Money, Joan Hampson, & John Hampson (Volumes 96/6, 97/4, 98/1). This publication series marks the birth of the new treatment paradigm that was installed in what I call intersexualization.¹ The new protocol was called ‘sex reassignment’ and its goal was to determine the optimum gender of rearing (OGR) for newborns with so-called ambiguous genitalia. The authors wrote that the direction of this ‘sex reassignment’ procedure should depend on the appearance and functionality of the outer genitalia, considering also the likelihood that they could be surgically altered in accordance with the assigned gender role as either penetrating or penetrable. The aim of the treatment promoted in the research by Money et al. was that ‘patients’ should “establish their gender with unambiguous certainty” (Money, Hampson, & Hampson, 1955b: 294). Money set the crucial age for this ‘sex reassignment’ procedure at around 18 months (Money et al., 1955b: 289). The possibility of surgical intervention was central in the determination of the OGR. Money and his team recommended clitor(id)ectomy and vaginoplasty as central to ‘intersex management’ and their advice is still alive and well today.² “The import of the work by Money and the Hampsons in shaping protocols for intersex treatment cannot be overstated,” as Lisa Downing, Iain Morland and Nikki Sullivan argue in their comprehensive book on Money and his body of work (2014: 4).

In the course of this chapter, I touch on the discursive and material preconditions that surrounded and impregnated Money’s theoretical and practical engagement with what he deemed to be a ‘psychosexual emergency.’ These preconditions most notably include psychoanalytical referencing and surgical techniques. My intention is to demonstrate how Money et al. constructed their research-object of the psychopathological hermaphrodite. As well, my research reveals that these scientists conveniently ignored the fact that their sample did not support their conclusions. In fact, they construed the concept of gender role in order to render their treatment recommendations comprehensible. Through references to stereotypical masculine and feminine behavior and appearance, they justified the necessity of developing a stable gender role for the intersex child that was congruent with one set of surgically constructed genitals. They were able to essentialize and naturalize a binary notion of gender role by arguing that once ingrained, it is not reversible. I subsequently analyze how the term of innate bisexuality is woven into their neo-Freudian approach to the psychosexual; moreover, I uncover how Money et al. exclusively used those theories by Freud, which fed their argument of the bi-polarity of gender roles, which they based on the theory of dimorphic sexes. In the second part of this chapter, I demonstrate how stereotypes about people who are expected to live in a feminine gender role were used to consolidate the phallocentric and heteronormative organization of twentieth-century society. As I will show, the reinforcement and reinscription of phallogocentrism is literally ‘managed’ by surgical techniques that erase the (‘enlarged’) clitoris because it is considered to be phallic flesh that threatens the bi-polar construction of sex and gender on a psychological as well as biological level. I further demonstrate that current debates on intersexualization continue to be heavily influenced by Money’s treatment recommendations. Any researcher or clinician who currently takes part in intersexualization refers, if not to Money directly, at least to his collaborators or students.³

John Money and the optimum gender of rearing (OGR)

In 1952, John Money wrote his PhD thesis entitled Hermaphroditism: An Inquiry in the Human Nature of a Paradox at Harvard University (cited in Karkazis, 2008; Klöppel, 2010). His dissertation sought to demonstrate that anatomy does not determine a person’s subjectivity with regards to gender. Most astonishingly, Money later ignored his own findings and started building a new theory around a different, if not to say opposite, paradigm. Throughout his professional life, Money continuously contradicted his own (early) findings in order to establish his treatment paradigm. For infants deemed to have ‘ambiguous genitals,’ he began advocating surgery within the first 18 months after birth to create genitals that matched the sex assigned to the newborn. This development may in part be due to the academic environment Money joined at Johns Hopkins University. Money himself never studied psychology or medicine, yet he joined a team of medical doctors. Also at Johns Hopkins was Hugh Hampton Young, a genitourinary surgeon who had published on hermaphroditism since 1921 and had extensive experience treating urological conditions (Young and Davis, 1926; Karkazis, 2008: 43). Lawson Wilkins later joined Johns Hopkins as director of the Endocrine Clinic. Wilkins published The Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence (Wilkins, 1950), which argued that sex reassignment in intersexualized newborns should be decided according to the appearance of the external genitals and not according to the gonads.

Initial sex reassignment should be followed by cosmetic genital surgery and hormones (Wilkins, 1950: 274). At this time, Wilkins still cautioned against radical plastic surgery, but five years later he argued that sex reassignment—including genital surgery—should be pursued in the first 18 months of life (Wilkins, Grumbach, Van Wyk, Shepard, & Papadatos, 1955: 297). His research studied 100 intersexualized people (later also seen by Money, Joan Hampson, and John Hampson). Whereas his main focus was to promote the use of cortisone to conform bodies to match stereotypical secondary sexual characteristics, he also advocated surgery to create artificial genitals ‘appropriate’ in length, width, and depth. Because gonads (ovaries and testes) were no longer the sole indicator of ones true sex, the scientists also administered chromosomal or hormonal tests, Money, however, often dismissed the results as irrelevant in determining subsequent treatment. The tests were used to define a true sex even though the final decision was made according to the presumed best sex, the optimum gender of rearing (OGR), which means that for example even though the chromosomal sex was male, the OGR could be determined as female. The publication series from 1955 to 1957 marks the origin of the new treatment paradigm and established Money as the US-American authority on hermaphroditism.

The 1956 paper “Sexual Incongruities and Psychopathology: The Evidence of Human Hermaphroditism” offers an overarching view of the team’s approach. This paper was based on 94 people they categorized according to their respective ‘psychopathology.’⁴ Interestingly, Money, Hampson, & Hampson state: “In 95 per cent of our 94 cases, gender role and orientation corresponded unequivocally with the sex of assignment and rearing” (1956: 43). It is important to note that a year prior to this study, the team had identified seven possible variables when considering hermaphroditic sex and gender:

1. Assigned sex and sex of rearing
2. External genital morphology
3. Internal accessory reproductive structure
4. Hormonal sex and secondary sexual characteristics
5. Gonadal sex
6. Chromosomal sex
7. Gender role and orientation as male or female, established while growing up

(Money, Hampson, & Hampson, 1955a: 302 [my emphasis])

Their findings indicate that variables 1 and 7 correspond (gender role and orientation correspond with assigned sex and sex of rearing) even when they are at odds with 2–6. In other words, those raised as girls, felt themselves to be women and those raised as boys, felt themselves to be men irrespective of their external genitalia, gonads, and/or secondary characteristics.

The Question of Psychopathology

For Money et al., gender role was deeply intertwined with ‘sexual orientation’ (what today falls under the rubric of ‘sexual preference’). To achieve the desired unambiguous gender role, one must necessarily have heterosexual orientation (Money et al., 1955b: 259). Proper gender role and adequate psycho-social integration into heteronormative society (not healthy/functioning ovaries, testes, uterus, etc.) are their preconditions for reproduction. In Money et al.’s 1955 to 1957 publications, the idea of gender role was developed into the key factor for psychosexual development. Psychologically “healthy” and “normal” development depended upon the “inner conviction” of being either male or female (289). Bodily integrity and the preservation of reproductive capacity do not feature in Money et al.’s treatment recommendations. They recommended gender assignment be based on the subject’s future ability to become a feminine woman or a masculine man capable of marrying the ‘opposite sex’ and forming a nuclear family (or adopting if unable to reproduce).

In their assessment of psychopathology Money et al. stated that “in only 94 patients, therefore, was there any question of psychological nonhealthiness on grounds of a demonstrably ambiguous gender role and orientation” (Money et al. 1956: 43). Of the breakdown into “healthy,” “mildly nonhealthy,” “moderately nonhealthy,” and “severely (morbidly) nonhealthy,” only five were classified as psychologically “severely (morbidly) nonhealthy” (44). Given the lack of strong correspondence between hermaphroditic individuals and psychopathological traits in their own study, how did Money et al. justify further research into sexual incongruities and psychopathology? What made them continue in the absence of evidence linking “sexual incongruities” to psychopathology? One wonders what the relevance of their research was, given “the most noteworthy finding […] is the conspicuous absence of severe psychologic disorder” (46)? And one cannot help but note that there was of course a personal motive in this research: the researchers would have been out of a job had there been nothing left to be researched. By continuing to invest in finding a link, they actually in effect created hermaphroditism/intersexuality as pathological.

The Obsession to Categorize

From the list of the seven variables, different so-called intersex conditions were extracted. Michel Foucault has shown how medicine came to be increasingly constituted by “the medical bipolarity of the normal and the pathological” in the nineteenth century (1973: 35). Money et al. created new classificatory systems for the concepts of gender, sex, and sexuality. According to Edward Said (1978), the nineteenth century shows an obsession to categorize—Money et al. prove that this obsession continued far into the twentieth century. Lisa Downing’s, Iain Morland’s, and Nikki Sullivan’s book Fuckology testifies to Money’s “passion for creating taxonomies” (2014: 2). The compulsion to categorize is symptomatic in the processes of intersexualization and all other processes of pathologization. This development of categorization went hand in hand with the establishment of medical expertise and experts authorized to evaluate, diagnose, and treat individuals. So, the production of medical knowledge about the phantasm of intersexuality is intrinsically connected to power.

Foucault discerns the psy-sciences, what he calls the disciplines that are assigned to examine the mind. Bio-power is a set of several disciplinary operations that consists of and encompasses a totalizing means of the organization of subjects (1975). The effect of the organization of subjects is caused by the new disciplinary power he identified; this power is not negative but creative. The power-knowledge complex that is produced over the bodies of intersexualized children excels in the material-discursive effects medical expert knowledge can have. Foucault argues elsewhere that “knowledge is not made for understanding; it is made for cutting” (1977: 154). I suggest that the machinery of diagnosis and treatment in intersexualization evolves literally as a cutting scalpel. In the process of intersexualization this means the development of increasingly intricate criteria, such as the list of seven.

Bio-power is formed at the intersection of scientific knowledge and societal systems of organization. Paul Rabinow and Nikolas Rose “use the term ‘biopolitics’ to embrace all the specific strategies and contestations over problematizations of collective human vitality, morbidity and mortality; over the forms of knowledge, regimes of authority and practices of intervention that are desirable, legitimate and efficacious” (2006: 197). Thereby they imply that knowledge as well as ethical consideration about life and death, about health and sickness and their demarcations as well as treatments are bound up with political imperatives, decisions, and configurations in the broadest sense. Rose suggests that bio-politics has become the dominant regime of control of bodies “through a system of integrated scientific discourses and social mechanisms” (2001: 38). Foucault uses the terms bio-power and bio-politics to diagnose a social system organized in the body and with the body. The body—‘any-body’ is subjected to normalizing power/knowledge complexes that are inextricable from medicalizing and pathologizing discourses. Beatriz Preciado calls this an “operation theater”: a complex system of coordinates that produces, locates, and organizes bodies in society (2003). It is not only unusual, odd, ambiguous, or deviant bodies that the logic of bio-power extends to, but all bodies and subjectivities in their difference and multiplicities are subjected to this “operation theater.” Unique to the case of intersex bodies, however, is that they are subjected to the cutting scalpel as well as to the ideological, symbolical, and political implications of bio-power that penetrate all bodies. Intersexualized individuals are produced in the course of their medicalization and their pathologization; they are created as such. And this is not to say that there wouldn’t be numerous variations of bodies—this is to say that there would not only be intersex, female, and male but many more. Male and female bodies are just as much created as intersex–—they are just not subjected to surgery. At least not to sex-reassignment surgery—the growing industry of cosmetic surgery of course testifies to the concept of bio-politics. Bio-politics operates in intersexualization in the sense that it organizes sex into only three categories, which are easily count- and therefore controllable.

To support their new treatment recommendations on so-called sexual incongruities and psychopathology, Money et al. called upon a Freudian psychoanalytic discourse of sexuality:

Few people acquainted with Freudianism and its impact on the theories of psychology and psychiatry can fail to be aware that sexuality, in its broadest sense, has been given an important place in theories about the genesis of psychiatric disorders. It is appropriate, therefore, to examine the evidence of human hermaphroditism in relation to psychopathology.

(1956: 43)

Ironically, Money et al. write that hermaphroditism must be interrogated in relation to psychopathology—despite the fact that, their own data undermines such a conclusion. Again, in this paper, which is titled “Sexual Incongruities and Psychopatholoy: The Evidence of Human Hermaphroditism” Money et al. state on the first page, that “in 95 per cent of our 94 cases, gender role and orientation corresponded unequivocally with the sex of assignment and rearing” (1956: 43). And they end their classification of psychologically non-/healthy hermaphrodites with the statement that “it proved quite possible for a patient to grow up psychologically healthy in the sex contradicted by chromosomes and gonads and partially contradicted by genial appearance” (52). And, they find th...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• Introduction: “I am who I am and I’m proud of myself”
• PART I The Clinic
• PART II The Colony
• Conclusion
• Index